<?php
/* @var $this MedicalHistoryController */
/* @var $model MedicalHistory */
/* @var $form CActiveForm */
?>

<div class="form">

<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'medical-history-form',
	'enableAjaxValidation'=>false,
)); ?>

	<p class="note">Fields with <span class="required">*</span> are required.</p>

	<?php echo $form->errorSummary($model); ?>

	<div class="row">
		<?php echo $form->labelEx($model,'pregnant'); ?>
		<?php echo $form->textField($model,'pregnant',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'pregnant'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'allergy'); ?>
		<?php echo $form->textField($model,'allergy',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'allergy'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'allergyyes'); ?>
		<?php echo $form->textField($model,'allergyyes',array('size'=>60,'maxlength'=>200)); ?>
		<?php echo $form->error($model,'allergyyes'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'medical_list'); ?>
		<?php echo $form->textField($model,'medical_list',array('size'=>60,'maxlength'=>200)); ?>
		<?php echo $form->error($model,'medical_list'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'major_injuries'); ?>
		<?php echo $form->textField($model,'major_injuries',array('size'=>60,'maxlength'=>200)); ?>
		<?php echo $form->error($model,'major_injuries'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'lazy_eye'); ?>
		<?php echo $form->textField($model,'lazy_eye',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'lazy_eye'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'drooping_eyelid'); ?>
		<?php echo $form->textField($model,'drooping_eyelid',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'drooping_eyelid'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'galucoma'); ?>
		<?php echo $form->textField($model,'galucoma',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'galucoma'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'retinal'); ?>
		<?php echo $form->textField($model,'retinal',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'retinal'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'catatracts'); ?>
		<?php echo $form->textField($model,'catatracts',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'catatracts'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'crossed_eye'); ?>
		<?php echo $form->textField($model,'crossed_eye',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'crossed_eye'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'eye_infect'); ?>
		<?php echo $form->textField($model,'eye_infect',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'eye_infect'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'eye_injury'); ?>
		<?php echo $form->textField($model,'eye_injury',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'eye_injury'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'wearing_eyeglasses'); ?>
		<?php echo $form->textField($model,'wearing_eyeglasses',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'wearing_eyeglasses'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'wearing_contact'); ?>
		<?php echo $form->textField($model,'wearing_contact',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'wearing_contact'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'wearing_eyeglasses_old'); ?>
		<?php echo $form->textField($model,'wearing_eyeglasses_old',array('size'=>50,'maxlength'=>50)); ?>
		<?php echo $form->error($model,'wearing_eyeglasses_old'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'wearing_contact_old'); ?>
		<?php echo $form->textField($model,'wearing_contact_old',array('size'=>50,'maxlength'=>50)); ?>
		<?php echo $form->error($model,'wearing_contact_old'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'contact_type'); ?>
		<?php echo $form->textField($model,'contact_type',array('size'=>20,'maxlength'=>20)); ?>
		<?php echo $form->error($model,'contact_type'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'comfortable'); ?>
		<?php echo $form->textField($model,'comfortable',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'comfortable'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'personalinfo_id'); ?>
		<?php echo $form->textField($model,'personalinfo_id'); ?>
		<?php echo $form->error($model,'personalinfo_id'); ?>
	</div>

	<div class="row buttons">
		<?php echo CHtml::submitButton($model->isNewRecord ? 'Create' : 'Save'); ?>
	</div>

<?php $this->endWidget(); ?>

</div><!-- form -->